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May 25, 2020

News | Health | Coronavirus: Administration leaves testing responsibility to states in report to Congress

Amy Goldstein



In a report to Congress, the Trump administration is pledging to buy 100 million swabs by the year’s end and distribute them to states to help expand the nation’s capacity to test for the novel coronavirus.
The report, delivered on the Sunday deadline lawmakers had set for federal health officials to submit a national testing strategy, doubles down on the administration’s stance that individual states, not the federal government, should bear primary responsibility for carrying out diagnostic tests to help curb the pandemic.
The Washington Post obtained the 81-page document, called Covid-19 Strategic Testing Plan, from an individual on Capitol Hill who was not authorized to disclose it. Federal health officials did not release it publicly, submitting it to four congressional committees as required by law.
The plan,sought by public health experts and congressional Democrats since the virus began circulating in the United States in late February, arrived as the nation’s covid-19 cases exceeded 1.6 million and deaths closed in on 100,000 — both the highest in the world. Public health authorities emphasize that diagnostic testing to identify who is infected, along with antibody testing to determine who might have immunity, are crucial tools to slow the spread of the highly infectious virus and to develop strategies tomake it safe for states and communities to reopen. Without a nationwide strategy, states have developed their own approaches, creating a patchwork, with some parts of the country doing far more testing than others.
The administration’s testing plan says every state should aim to test at least 2 percent of its population in May and June. The document, however, lists the testing targets each state reported to federal officials for May, totaling 12.9 million tests nationwide, rather than laying out goals the federal government is calling on each state to meet.
“With support from the federal government to ensure states are meeting goals, the state plans for testing will advance the safe opening of America,” the plan says.
And in keeping with the portrayal by Trump and others in his administration that the pandemic is under control, the document says that epidemiologists and public health organizations have said that if 10 percent of tests are positive for the virus over the course of a week, that is “enough to assure broad coverage of the population.” It says that 41 states already have achieved that goal.
Congress’s Democratic leaders were expected to issue a reaction to the plan within hours of receiving it, but had not done so by Sunday evening.
The availability of tests and test kits has been a critical problem with the administration’s pandemic response since the beginning. Testing began late because of problems in the central lab at the Centers for Disease Control and Prevention, which was at first the only source of a diagnostic test. Even when academic and commercial labs began developing their tests, government bureaucracy delayed their approval. And the supply of testing materials has been a recurrent problem, though the White House consistently says there are ample tests.
The number of tests nationwide has hovered lately around 400,000 a day, according to the Covid Tracking Project, which compiles and publishes state testing data. That is hundreds of thousands a day fewer than various research models say is necessary.
The new report, prepared by the Department of Health and Human Services, elaborates on a blueprint the White House released last month for increasing the nation’s capacity for coronavirus testing. That 11-page document, released April 27, also placed responsibility primarily on states, saying the federal government’s role would be to “provide strategic direction and technical assistance,” while regulating tests and testing equipment. The government would “act as supplier of last resort,” it said.
The blueprint said, for instance, that it was up to each state to devise a testing plan; determine where people could get tested; and monitor and seek to contain outbreaks. The private sector also had a role, developing new tests, getting them approved by federal regulators, and speeding up production of the tests and needed materials — all features of the strategy HHS submitted to Congress Sunday, as well.
Upon its release, the blueprint was immediately derided as inadequate by leading public health officials and other experts. The president issued it hours after a bipartisan group of 16 prominent former federal officials and academics — all with health-care expertise — sent a letter to lawmakers urging them to devote significantly more money to expand testing, as well as do more public health tracing to identity the contacts of infected people and then isolate them.
Congressional Democrats lambasted the blueprint as flawed. House Energy and Commerce Committee Chairman Frank Pallone Jr. (D-N.J.) called it “totally lacking in credibility,” saying that it fell short of a national plan, was not enforceable, and was not accompanied by federal funding.
Under a $484 billion coronavirus relief package Congress adopted in late April — and that Trump signed into law — lawmakers devoted $25 billion for testing. The law says that each state must submit to HHS a detailed coronavirus testing plan for the rest of this year. It also requires the department to submit a national testing strategy to the four congressional committees — including plans to increase the amount of testing available and to curb disparities among different communities. The deadline for both was Sunday.
Some of the new testing plan borrows from advice federal health officials have given before. It says, for instance, that they will assist states if they need help in developing testing and surveillance efforts targeted to workers in 16 “critical infrastructure sectors” the CDC previously has addressed, including those in health care and food and agriculture.
It also includes an assertion made recently by Brett Giroir, an assistant HHS secretary in charge of testing, that the nation will have the capacity to perform 40 million to 50 million diagnostic tests a month by the end of the summer.
The document mentions actions the White House has taken already. They include collaborating with companies to operate drive-though testing sites, though fewer have been established than the president indicated when the idea was first announced.
The document also reiterates that the White House’s plan for reopening the country calls for government officials to work with private companies on researching and developing new testing approaches.

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